NCPDP Universal Patient Identifier Guidance Document

Universal Patient Identifier Guidance Document

Version 1.1

This document provides guidance on the possible use of a universal patient identifier(s) within the NCPDP

Standards.

October 2020

National Council for Prescription Drug Programs

9240 East Raintree Drive

Scottsdale, AZ 85260

Phone: (480) 477-1000

Fax: (480) 767-1042

E-mail: ncpdp@

Universal Patient Identifier Guidance Document

Version 1.1

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Published by:

National Council for Prescription Drug Programs

Publication History:

Version 1.0 July 2019

Version 1.1 October 2020

Copyright ? 2020

All rights reserved.

Universal Patient Identifier Guidance Document

TABLE OF CONTENTS

Disclaimer ......................................................................................................................................... 4

1.

Executive Summary ..................................................................................................................... 5

2.

Purpose ...................................................................................................................................... 6

3.

Definitions .................................................................................................................................. 7

4.

High Level Flow ........................................................................................................................... 8

4.1 Actors ....................................................................................................................................... 8

5.

NCPDP Standards ...................................................................................................................... 10

6.

Use Cases.................................................................................................................................. 15

6.1 Both Submitter and Receiver use the same Enumerating Entity for a UPI.................................. 15

6.2 Submitter and Receiver Use the Same Two Enumerating Entities ............................................. 17

6.3 The submitter and the receiver use two enumerating entities of which one is shared ............... 20

6.4 Submitter and Receiver Use Two Different Enumerating Entities .............................................. 20

7.

Recommendations .................................................................................................................... 22

8.

Conclusion ................................................................................................................................ 23

9.

Frequently Asked Questions ...................................................................................................... 24

10. Appendix A. History of Changes ................................................................................................. 25

Version 1.1

October 2020

***OFFICIAL RELEASE***

National Council for Prescription Drug Programs, Inc.

3

Universal Patient Identifier Guidance Document

Disclaimer

This document is Copyright ? 2020 by the National Council for Prescription Drug Programs (NCPDP). It

may be freely redistributed in its entirety provided this copyright notice is not removed. It may not be

sold for profit or used in commercial documents without the written permission of the copyright

holders. This document is provided ¡°as is¡± without any expressed or implied warranty.

While all information in this document is believed to be correct at the time of writing, this document is

for educational purposes only and does not purport to provide legal advice. If you require legal advice,

you should consult with an attorney. The information provided here is for reference use only and does

not constitute the rendering of legal, financial or other professional advice or recommendations by

NCPDP.

The existence of a link or organizational reference in any of the following materials should not be

assumed as an endorsement by NCPDP.

The writers of this paper will review and possibly update their recommendations should any significant

changes occur.

This document is for Education and Awareness Use Only.

Version 1.1

October 2020

***OFFICIAL RELEASE***

National Council for Prescription Drug Programs, Inc.

4

Universal Patient Identifier Guidance Document

1. Executive Summary

Proper identification of a patient is critical to many communications in healthcare. Today, stakeholders

communicate the identity of the patient in a variety of ways that can result in record duplication and/or

mistaken identity. Misidentification of a patient has been shown to lead to errors or inadequate care for the

patient1. NCPDP has identified the need for proper identification of the patient as a means to improve patient

safety and ensure positive patient outcomes.

A universal patient identifier (UPI) uniquely identifies a person for purposes of healthcare operations. An

ideal UPI would be assigned at birth, stay with a patient for their entire lifetime and never be used for any

other patient. It enables providers and other stakeholders to act on behalf of a patient with assurance that

relevant information about a patient is collected, and it enables healthcare providers to communicate about

patients with greater certainty about the identity of each patient being served.

When trading partners communicate with a UPI, the receiver can more accurately identify the patient.

Because the receiver is better able to accurately identify the patient, the occurrence of transactions being

associated to the wrong patient is lowered, clinical outcomes are improved and transactions being rejected

are reduced.

As a result of this initiative, many NCPDP standards have been updated to allow usage of a UPI so trading

partners can more precisely communicate who each patient is.

1



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National Council for Prescription Drug Programs, Inc.

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